Health 2.0, Medicine 2.0 and Web 2.0: Enabling technologies for practice, policy and systems

1. ITCH 2009 Plenary
Sunday, February 22, 2009
Don Juzwishin CHE PhD

2.  1987: TODAY’S CHALLENGES -
TOMORROW’S SOLUTIONS
 1990: IMPROVING COMMUNITY HEALTH
THROUGH APPLIED TECHNOLOGY
 1994: CHANGING OPPORTUNITIES
 1996: APPROPRIATE SYSTEMS /
APPROPRIATE DECISIONS
 1998: NEW PARTNERSHIPS: BETTER CARE
 2000: FROM POTENTIAL TO PRACTICE
 2007 - TODAY’S INFORMATION FOR
TOMORROW’S IMPROVEMENTS

3. REVOLUTIONIZING HEALTH
CARE with INFORMATICS:
FROM RESEARCH to
PRACTICE

4.  to offer or accept a challenge; "threw down
the gauntlet"; "took up the gauntlet"
 form of punishment in which a person is
forced to run between two lines of men
facing each other and armed with clubs or
whips to beat the victim

5. REVOLUTIONIZING
HEALTH CARE with
INFORMATICS:
FROM RESEARCH to
PRACTICE

6. Health 2.0, Medicine 2.0
and Web 2.0: Enabling
technologies for practice,
policy and systems

7.  Power and will of the people
 Web 2.0
 Power and will of autonomous health care
providers and researchers committed to
collaborate and advance best practice and
continuous quality improvement
 Medicine 2.0
 Power and will of the state to achieve a high
performing health care system and
improvements in the health and quality of life of
its citizens
 Health 2.0

8.  Health informatics is a necessary condition
for the revolution but it is not sufficient – it
needs a cultural revolution to take place as
well
 The fundamental tenant of this address is that
improvements to the health care system must
come from reforms to its structures and processes
not by imposing e-health on an archaic artifact

9. Data source: 2005 Canadian Internet Use Survey.
Figure source: Statistics Canada, 2008, "Getting a second opinion: Health information and the Internet", Health Reports, Vol. 19 No. 1, catalogue number 82-003-XWE.

10. Data source: 2005 Canadian Internet Use Survey.
Figure source: Statistics Canada, 2008, "Getting a second opinion: Health information and the Internet", Health Reports, Vol. 19 No. 1, catalogue number 82-003-XWE.

11.  While most (94%) think it’s important to have
access to one’s own medical history, only six
in ten (60%) say its ‘easy’ to access them
 a majority (55%) of Canadians indicate their
medical history is tracked on paper, not
electronically (30%)
 Simpson, 2008, Ipsos survey

12.  (93%) Canadians believe that medical errors
can be prevented by improving collaboration
between medical professionals using
technology, and that efficiencies could be
created through the additional exchange of
information amongst care gives and medical
professionals (91%).
 Simpson, 2008, Ipsos Survey

13.  A similar proportion (87%) is of the opinion that
electronic health records help medical
professionals make better decisions when
address health issues of patients.
 Nine in ten (91%) believe that the information
they get from their medical professionals allows
them to take an active role in managing their
own health and the health of the family
members.
 Simpson, 2008, Ipsos Survey

14.  Similarly, most (89%) say they want to play a
more active role in the health care decisions
made for them and their family
 Simpson, 2008, Ipsos Survey

15.  Three rules of open spaces that have
emerged on the Internet
▪ (1) no body owns it,
▪ (2) everybody uses it and
▪ (3) anyone can improve it.
 They characterize the Internet with (1) openness,
(2) peering, (3) sharing, and (4) acting globally
▪ Tapscott and Williams

16. Informed
Improved
Public Improved
Web 2.0 Knowledge
Reforms Outcomes
Providers
Health 2.0 Practices Population
Policy Makers health
Personal Health
Medicine 2.0
Decision Makers
Policy
Decisions

17. Web 2.0, Health 2.0 and
Medicine 2.0 offer the
platform for the cultural
revolution to take place

18.  Changing trend of the World Wide Web and
web design
 Enhance creativity
 Communications
 Secure information sharing
 Collaboration
 Functionality
 Social networking, video sharing, wikis, blogs,
folksonomies

19.  "Health 2.0 is participatory healthcare
characterized by the ability to rapidly share,
classify and summarize individual health
information with the goals of improving
health care systems, experiences and
outcomes via integration of patients and
stakeholders.“
 Ian Furst
 http://waittimes.blogspot.com/

20.  “Medicine 2.0 applications, services and tools are
Web-based services for health care consumers,
caregivers, patients, health professionals, and
biomedical researchers, that use Web 2.0
technologies as well as semantic web and virtual
reality tools, to enable and facilitate specifically social
networking, participation, apomediation,
collaboration, and openness within and between
these user groups.”
▪ Eysenbach G
Medicine 2.0: Social Networking, Collaboration, Participation,
Apomediation, and Openness
J Med Internet Res 2008;10(3):e22
<URL: http://www.jmir.org/2008/3/e22/>

21.  Hughes et al. argue there are four major tensions
represented in the literature on Health/Medicine
2.0:
 lack of clear definitions;
 issues around the loss of control over information
traditionally the purview of health care providers;
 safety and the dangers of inaccurate information; and
 issues of ownership and privacy
 Hughes B, Joshi I, Wareham J
Health 2.0 and Medicine 2.0: Tensions and Controversies in the Field
J Med Internet Res 2008;10(3):e23
<URL: http://www.jmir.org/2008/3/e23/>

22.  It is now humanly impossible for health care
professionals to single handedly accumulate
and possess the knowledge to deliver the
health care with the safety and quality made
possible by current scientific knowledge

23.  It is unpardonable to ignore or not undertake
a policy action that will benefit the health of
the population or improve its quality of life.
 It is unpardonable to not undertake the
improvement of the functioning of the health
care system in respect to its effectiveness and
efficiency

24.  “Some problems are so complex that you
have to be highly intelligent and well
informed just to be undecided about them.”
 Laurence J. Peter

25.  Synergy between health care reform and
Web 2.0
 Synergism – the cooperative action of discrete
agencies such that the total effect is greater than
the sum of the effects taken independently

26.  Provide 24/7 access to high quality evidence on the
effectiveness of health care interventions
 Provide the opportunity for social networking, support
groups, sharing of experiences
 24/7 monitoring of health status parameters – smart
house
 Instantaneous feedback on medication effects
 Encourage health literacy being a priority in education
 The citizen, consumer, patient own their personal health
record
 Reduce adverse events
 Access to remote locations
 Support of chronic disease management and health
promotion

27.  Provide 24/7 access to high quality evidence on
effectiveness of health care interventions
 Provide immediate news of breakthrough
findings or cautions
 Identify and share international best practices
 Provide opportunity for immediate and trended
outcomes associated with interventions
 Offer opportunities for collaboration and
partnership
 Provide decision support tools
 New forms of education and continuing
education

28.  A storehouse of linked data
 Provide a bridge to anonymous data and
information on the citizen, customer, patient
community
 Facilitate clinical and field trials matching
client criteria and research design
requirements
 Bring them into the collaboratory
 Need to make explicit peer review processes

29.  Make explicit accountability relationships,
roles and responsibilities
 Provide transparency on the monitoring and
performance of the health care system
 Provide access to linked data bases
 Drive and link health policy informatics from
the sub cellular to the individual and
population health levels

30. • Potential to improve and inform citizen knowledge
and understanding
• Provide opportunity to shift the ownership of the
personal health record to the citizen
• Provide instantaneous access to the highest quality
evidence of clinical and cost effectiveness of health
care interventions to citizens, providers and policy
makers
• Provide the state with knowledge and insights of
what policy actions have what results

31.  Migrate the personal health record to
citizens, consumers, patients
 Provide 24/7 and universal access to high
quality evidence on the effectiveness of
health care interventions to citizens,
providers and policy makers
 Encourage apomediation
 Require transparent declaration of private
versus public interests in technologies

32.  Leadership
 Courage - sacrifices
 Vision
 Commitment
 Hard work
 Effective bridges between research, practice
& policy

33.  The reasonable man adapts himself to the
world; the unreasonable one persists in trying
to adapt the world to himself. Therefore all
progress depends on the unreasonable man.
 George Bernard Shaw (1856 - 1950), Man
and Superman (1903) "Maxims for
Revolutionists"